Optimizing outcomes with less than more: multi-institutional experience of fast-forward fractionation and the impact of dosimetric parameters on toxicity in breast cancer patients - Report - MDSpire

Optimizing outcomes with less than more: multi-institutional experience of fast-forward fractionation and the impact of dosimetric parameters on toxicity in breast cancer patients

  • By

  • H. Habibullah

  • M. Alotaibi

  • H. Almarzouki

  • Z. Mulla

  • M. Elbaiomy

  • R. Alahmadi

  • A. Ahmed

  • Y. Bahadur

  • R. Ujaimi

  • E. Senan

  • M. Attar

  • A. Bamakhramah

  • H. Altoukhi

  • H. Muamenah

  • O. Iskanderani

  • R. Garout

  • J. Alturkistani

  • H. Hijazi

  • Z. Jastaniah

  • June 10, 2026

  • 0 min

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Clinical Report: Enhancing Treatment Efficacy with Fewer Sessions

Overview

This study evaluates the safety and toxicity of ultra-hypofractionated radiotherapy (RT) in breast cancer patients, demonstrating that 26 Gy in five fractions is well tolerated. Key findings include significant correlations between dosimetric parameters and observed toxicities.

Background

The rising incidence of breast cancer in Saudi Arabia necessitates effective treatment strategies. Recent advancements in radiotherapy, particularly hypofractionation, have shown promise in improving outcomes while minimizing toxicity. Understanding the toxicity profiles associated with these treatments is crucial for optimizing patient care.

Data Highlights

ToxicityPercentageGrade III
Breast skin dermatitis82.35%5%
Hyperpigmentation72.9%N/A
Breast discomfort30.3%N/A
Breast hardness17.6%N/A
Breast pain (≥5/10)15%N/A

Key Findings

  • Breast skin dermatitis was the most common side effect, affecting 82.35% of patients.
  • Hyperpigmentation occurred in 72.9% of patients.
  • 15% of patients reported breast pain rated ≥5 out of 10.
  • Breast pain correlated significantly with larger breast volume and higher V107% values (p=0.013, p=0.012).
  • Breast skin dermatitis was significantly correlated with breast CTV, BMI, and breast separation (p=0.0001, 0.015, 0.001).

Clinical Implications

The findings suggest that careful consideration of dosimetric factors, such as breast volume and BMI, may help mitigate toxicity in patients undergoing ultra-hypofractionated RT. This information can guide clinicians in treatment planning to enhance patient safety.

Conclusion

Ultra-hypofractionated RT with a 26 Gy in five fractions schedule is a viable option for breast cancer treatment, with manageable toxicity profiles. Further optimization of dosimetric parameters may improve patient outcomes.

Related Resources & Content

  1. Brunt et al, The Lancet, 2020 -- FAST-Forward Trial: Long-Term Outcomes With Adjuvant Hypofractionated Radiotherapy for 1 vs 3 Weeks in Early Breast Cancer
  2. Lori J. Pierce, MD, FASTRO, FASCO, The ASCO Post, 2023 -- Expert Point of View
  3. Elizabeth Nichols, MD, The ASCO Post, 2021 -- Expert Point of View
  4. Frontiers in Oncology, 2026 -- Efficacy and safety of hypofractionated versus conventional radiotherapy in breast cancer: a systematic review and meta-analysis
  5. PMC, 2020 -- Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial
  6. Royal College of Radiologists Radiotherapy Dose Fractionation, 4th edition
  7. DEGRO statement on the FAST-Forward trial: 10-year data of ultrahypofractionated radiation therapy for breast cancer
  8. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial - PMC
  9. Volumetric Modulated Arc Therapy for 26 Gy in 5 Fractions Whole Breast Irradiation for Breast Cancer - PMC
  10. Cardiopulmonary Toxicity Risk Following Ultrahypofractionated Breast Radiotherapy Regimens - ScienceDirect

Original Source(s)

Optimizing outcomes with less than more: multi-institutional experience of fast-forward fractionation and the impact of dosimetric parameters on toxicity in breast cancer patients

  • by H. Habibullah, M. Alotaibi, H. Almarzouki, Z. Mulla, M. Elbaiomy, R. Alahmadi, A. Ahmed, Y. Bahadur, R. Ujaimi, E. Senan, M. Attar, A. Bamakhramah, H. Altoukhi, H. Muamenah, O. Iskanderani, R. Garout, J. Alturkistani, H. Hijazi, Z. Jastaniah

  • June 10, 2026

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